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1、Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time CRRTCRRT的适应证和临床应用的适应证和临床应用 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 内 容 提 要 nCRRT的一般概况 nCRRT的临床应用 nCRRT的地位评价 Our greatest wea
2、kness lies in giving up The most certain way to succeed is always to try just one more time C R R T 的 定 义 nContinuous Renal Replacement Therapy 连续性肾脏替代治疗 n1995年美国San Diego 第一届CRRT大会会议 nCRRT是指一组体外血液净化的治疗技术 目的是替代功能受损的肾脏 每天持续治疗24h或接近24h nCBP 持续性血液净化 n中国特色的日间CRRT和武汉市医保认可的8小时CRRT Our greatest weakness li
3、es in giving up The most certain way to succeed is always to try just one more time C R R T 的 种 类 n连续性动静脉血液滤过 CAVH 1977年 n连续性静 静脉血液滤过 CVVH 1979年 n缓慢连续性超滤 SCUF 1980年 n连续性动静脉血液透析 CAVHD 1984年 n连续性静 静脉血液透析 CVVHD 1986年 n连续性静 静脉血液透析滤过 CVVHDF 1986年 n连续性高容量血液滤过 HVHF 1992年 n连续性高通量透析 CHFD 1998年 n连续性血浆滤过吸附 CPF
4、A 1998年 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 血液透析原理 n弥散与透析 n对流与滤过 n吸附与灌流 n超滤 对水的清除 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Diffusion The movement of solutes from
5、 a higher to a lower solute concentration area 弥散 Diffusion 影响弥散因素 血流速度 透析液流速 膜面积 浓度差 溶质大小 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Convection The movement of solutes with a water flow solvent drag e g the movement of membrane permea
6、ble solutes with ultrafiltered water 对流 Convection 影响对流因素 膜性质 对流量 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time positive pressurenegative pressure Ultrafiltration The movement of fluid through a membrane caused by a pressure gradient 超滤 U
7、ltrafiltration 影响超滤因素 机器设定值 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time C R R T 与 I H D 的 比 较 n血流动力学稳定 n溶质清除率高 n清除炎性介质 n提供营养支持 n不易发生失衡和反跳 n不受水处理装置限制 Our greatest weakness lies in giving up The most certain way to succeed is always to tr
8、y just one more time C R R T 的 作 用 n强 大 的 净 化 效 应 传 统 B l o o d p u r i f i c a t i o n n调 节 内 环 境 平 衡 现 代 R e g u l a t e H o m e o s t a s i s n细 胞 保 护 作 用 最 新 C e l l u l a r P r o t e c t i o n 黎磊石 CRRT治疗的发展与存在的问题 2007 Our greatest weakness lies in giving up The most certain way to succeed is al
9、ways to try just one more time C R R T 的 净 化 作 用 n炎性介质 n代谢产物 n毒物 n药物 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Non renal indications for continuous renal replacement therapy Miet Schetz Kidney Int 1999 56 s88 94 Our greatest weakness
10、lies in giving up The most certain way to succeed is always to try just one more time 调 节 机 体 内 环 境 平 衡 作 用 n调节容量平衡 n调节离子平衡 n调节酸碱平衡 n调节温度平衡 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 细胞保护作用 n保护内皮细胞 n调节免疫细胞功能 Our greatest weakness lies
11、in giving up The most certain way to succeed is always to try just one more time 内 容 提 要 nCRRT的概念 nCRRT的临床应用 nCRRT的地位评价 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time C R R T 的 临 床 应 用 nCRRT适应证有哪些 nCRRT治疗是否比传统治疗有优势 n何时开始CRRT治疗 n选择何种血液净化模式
12、n如何确定CRRT的剂量 nCRRT置换液配方选择 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time C R R T 适 应 证 有 哪 些 n肾脏疾病 n非肾脏疾病 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time CRRT治疗是否比传统治疗有优势 CRRT vs
13、IHD CRRT vs SLEDD or EDD Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 何时开始CRRT治疗 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time Our greatest weakness lies in giving up The most
14、 certain way to succeed is always to try just one more time 如何确定CRRT的剂量 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time C R R T 最 佳 治 疗 剂 量 窗 口 Kellum Ronco Nat Rev Nephrol 6 4 191 2 2010 Our greatest weakness lies in giving up The most cer
15、tain way to succeed is always to try just one more time CRRT置换液配方选择 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time C R R T 置 换 液 配 方 n个体化 nPort配方 第一组 生理盐水1000ml 10 氯化钙10ml 第二组 生理盐水1000ml 50 硫酸镁1 6ml 第三组 生理盐水1000ml 第四组 5 葡萄糖1000ml 5 碳酸氢钠250
16、ml 根据需要适量加10 氯化钾 n我院曾经基本配方 生理盐水3000ml 注射用水800ml 5 葡萄糖170ml 25 硫酸镁3 2ml 5 氯化钙20ml 10 氯化钾 12ml 或根据需要调整 以及 5 碳酸氢钠250ml 备注 10 葡萄糖酸钙 10 氯化钙 Our greatest weakness lies in giving up The most certain way to succeed is always to try just one more time 我 院 目 前 基 本 配 方 n生理盐水3000ml 注射用水 950ml 50 葡萄糖10ml 25 硫酸镁3 2ml 5 氯化 钙20ml 10 氯化钾 12ml 或根据需要调整 以及 5 碳酸氢钠250ml n8小时 每小时3L液体 共 计24L 碳酸氢钠另算 n n 0 9 0 9 氯化钠针氯化钠针 1000ml 221000ml 22 50 50 葡萄糖针葡萄糖针20ml 620ml 6 注射用水注射用水 500ml 12500ml 12 5 5 氯化钙针 氯化钙针 12 12 25 25 硫酸镁
